Improved outcome of children transplanted for high-risk leukemia by using a new strategy of cyclosporine-based GVHD prophylaxis
Improved outcome of children transplanted for high-risk leukemia by using a new strategy of cyclosporine-based GVHD prophylaxis
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DOI：
10.1038/bmt.2015.350
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发表时间：
2016-05-01
影响因子：
4.8
通讯作者：
Bertrand, Y.
中科院分区：
文献类型：
--
作者：
Bleyzac, N.;Cuzzubbo, D.;Bertrand, Y.
目前主要关注的是造血干细胞移植（HSCT）后施用的最佳免疫抑制疗法，以降低GvHD的毒性和复发率。我们报告的结果，高危白血病儿童移植与管理环孢素（CsA）为基础的GvHD预防的新方法。共纳入109例ALL或AML患儿中的110例HSCT，这些患儿在匹配的相关干细胞移植以及匹配或不匹配的非相关干细胞移植中接受了CsA，而没有接受麦考酚酯或甲氨蝶呤。CsA给药方案个体化，以获得特定的谷血药浓度值。I ~ II级和III ~ IV级急性GvHD发生率分别为69.1%和1.8%，慢性GvHD发生率为8.4%。GvHD在无关HSCT中既不比相关HSCT更频繁也不更严重。平均CsA谷浓度= 10（-3）的患者和MRD患者中，87%发生GvHD
There is currently a major concern regarding the optimal immunosuppression therapy to be administered after hematopoietic stem cell transplantation (HSCT) to reduce both the toxicity of GvHD and the rate of relapse. We report the outcome of high-risk leukemia children transplanted with a new way of managing cyclosporine (CsA)-based GvHD prophylaxis. A total of 110 HSCT in 109 ALL or AML children who received CsA without mycophenolate or methotrexate in matched related as well as in matched or mismatched unrelated stem cell transplantation were included. CsA dosage regimens were individualized to obtain specific trough blood concentrations values. The incidences of grade I-II and III-IV acute GvHD were 69.1% and 1.8%, respectively, and 8.4% for chronic GvHD. GvHD was neither more frequent nor severe in unrelated than in related HSCT. GvHD occurred in 87% of patients with a mean CsA trough concentration = 10(-3) and in those with MRD